Diabetes is a Financial Epidemic for the US Healthcare System

Summary:

Diabetes is a chronic health condition that affects millions of Americans and incurs significant financial costs on the healthcare system. According to the Centers for Disease Control and Prevention (CDC), over 34 million people in the United States have diabetes, and another 88 million have prediabetes, a condition that increases the risk of developing type 2 diabetes. The financial burden of diabetes on the healthcare system is staggering, with estimates ranging from hundreds of billions to over a trillion dollars annually.

Diabetes Introduction:

In 2018, an estimated 34.2 million Americans had been diagnosed with diabetes, representing 10.5% of the country's population. This figure does not include an additional 7.3 million adults who are believed to have undiagnosed diabetes. The most common form of the disease is type 2 diabetes, which is characterized by the body's improper use of insulin, and is usually diagnosed in adulthood. Type 1 diabetes, on the other hand, is caused by the body's inability to produce insulin and is more commonly diagnosed in childhood. Both types of diabetes can cause elevated levels of blood glucose which leads to serious complications over time such as cardiovascular disease, stroke, kidney damage, blindness, and limb amputation. It is estimated that diabetes and its related conditions lead to 8 million hospitalizations in the US each year.

2022 Fact: Per the CDC, 1 in 3 Americans will develop diabetes sometime in their lifetime! Look around the room, it’s likely one of you or more will fall into this bucket.

The direct costs of diabetes include the cost of medications, medical supplies, hospitalization, and re-admission to hospitals. According to a study published in the journal Diabetes Care, the total direct medical costs of diabetes in the United States in 2017 was $327 billion, which represents an increase of over 26% from 2012. The study also found that people with diabetes have medical expenses that are, on average, 2.3 times higher than those without diabetes.

In addition to direct medical costs, diabetes also incurs indirect costs, such as lost productivity and disability. A study published in the Journal of Occupational and Environmental Medicine estimated that the indirect costs of diabetes in the United States in 2002 were $90 billion. The study also found that people with diabetes miss an average of 6.2 days of work per year due to their condition, which leads to a significant loss of productivity.

The financial burden of diabetes is expected to continue to increase in the coming years as the prevalence of the disease continues to rise. According to a projection by the International Diabetes Federation, the total direct and indirect costs of diabetes in the United States will reach $802 billion by 2040.

One of the main drivers of the increasing costs of diabetes is the rising prevalence of the disease. According to the CDC, the number of adults with diabetes in the United States has increased by 45% over the past 20 years. The rise in diabetes is primarily driven by the increasing prevalence of obesity, which is a major risk factor for the development of type 2 diabetes.

Another driver of the increasing costs of diabetes is the aging of the population. As people age, their risk of developing diabetes increases, and older adults tend to have more complications from the disease. According to the CDC, the number of adults aged 65 years or older with diabetes has increased by over 50% over the past 20 years.

The financial burden of diabetes on the healthcare system is not only a significant economic concern but also a public health concern. Diabetes is a leading cause of heart disease, stroke, kidney failure, and amputations. It also increases the risk of other serious health conditions, such as depression, blindness, and hearing loss. Therefore, addressing the cost of diabetes is important not only for the economic well-being of the country but also for the health of its citizens.

To address the financial burden of diabetes on the healthcare system, several strategies have been proposed, including:

Investing in diabetes prevention and management programs: The CDC estimates that for every $1 invested in diabetes prevention, $5 is saved in medical costs.
Improving access to care for people with diabetes: Lack of access to care is a major barrier to diabetes management, and increasing access to care can improve health outcomes and reduce costs.
Encouraging the development of new diabetes treatments: New treatments can improve health outcomes and reduce costs by reducing the need for hospitalization and other expensive medical interventions.
Addressing the underlying social determinants of diabetes: Social determinants, such as poverty, lack of education, and lack of access to healthy food, are major risk factors for the development of diabetes. Addressing these underlying issues can help to reduce the burden of the disease on the healthcare system.

Hospital Admissions and Re-Admissions for Diabetes

2017 to Present Diabetes Cost and Prevalence for Diabetes

For every two hospital stays not involving a diabetes diagnosis, there is one stay with either of these diagnoses - 95% of which being attributed to Type 2 and 5%% associated with Type 1. This alarming trend demonstrates an urgency for improved resources in managing this chronic condition.

Hospital admission rates for diabetes are on the rise in America as well. According to data from the Centers for Disease Control and Prevention (CDC), an estimated 1.5 million Americans were hospitalized with a primary diagnosis of diabetes in 2017, representing a 4% increase from the number of hospitalizations reported in 2012 (1). Additionally, data from the Agency for Healthcare Research and Quality showed that admission rates for diabetes-related complications climbed 7.7% from 2012 to 2017, indicating that more people are being hospitalized for diabetes-related conditions (2).

Readmission rates for diabetes are also increasing in the United States. A study released by the Agency for Healthcare Research and Quality reported that the 30-day readmission rate for patients with a primary diagnosis of diabetes was 19.3% in 2017, which was a 2.5% increase from the rate reported in 2012 (2). Furthermore, data from The Leapfrog Group revealed that readmission rates for diabetes-related complications have also risen to 15.8%, a 4.7% increase since 2012 (3).

Diabetic ketoacidosis is a serious and potentially life-threatening complication of type 1 diabetes that occurs when there is an accumulation of acid in the blood due to excess glucose, or blood sugar. This occurs typically due to either insufficient insulin medicine or an infection and can require hospitalization for fluid replacement and insulin therapy. Unfortunately, the readmission rate after diabetic ketoacidosis treatment is surprisingly high at 20.2 percent, according to a study led by Hafeez Shaka, M.D., an internal medicine resident at John H. Stroger Jr. Hospital of Cook County, Chicago, and published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Using the 2017 National Readmissions Database, Shaka and his colleagues found that 91,401 diabetic ketoacidosis-related hospitalizations involved adults with type 1 diabetes who were alive at discharge from the hospital. The 30-day readmission rate was significantly higher in women than in men as well as patients leaving against medical advice during the first hospitalization. Other risk factors for readmission included having anemia, high blood pressure, or chronic kidney disease.

The researchers found that with each subsequent admission, not only was there double the chance of in-hospital death compared with the first hospitalization but also longer admissions and higher healthcare costs. This indicates a need to identify the risk factors for readmission in order to reduce the burden of readmissions. This could include ensuring that proper discharge planning is put into place, such as providing education about blood sugar control and managing other medical conditions, as well as making sure patients follow up with their diabetes care provider for glucose management.

The most comprehensive studies however are still 3-4 years behind… 2018 Statistics show the following trends.

Type 1 diabetes is especially prevalent among younger adults, while Type 2 diabetes affects more elderly patients. One-third (33.2 percent) of stays involving type 1 diabetes were for young adults aged 18 to 34 years; this compares with only around one in 60 (1.6 percent) of such stays resulting from Type 2 and 11.3% without any form of the disease present at all! Similarly, 9 out 50 people hospitalized as a result of having Type 1 Diabetes are children aged between one and seventeen - whereas less than 0 .1 % experienced hospitalization due to type two or none at all! In contrast, however, it's estimated that just over half (49%) of those hospitalizations relating to old age come down to particularly Type two - nearly five times higher than those suffering from no form whatsoever (33%), or even their counterparts afflicted by diagnosis number #one(12%).

Cost of Diabetes Reversal & Support Programs

The cost of diabetes reversal programs in the United States varies widely depending on the program, specific services offered and geographical location. According to research published in Diabetes Care, the average cost of a diabetes prevention program ranges from $400-$1,000 per person. This can vary greatly depending on the type of program and services offered.

For example, a diabetes reversal program offered by the Joslin Diabetes Center in Boston, Massachusetts offers a three-month intensive lifestyle change program for $2,000 per person. The cost includes an initial consultation and follow up visits with an endocrinologist, nutritionist, fitness instructor, and behavioral counselor.

At Regional Medical Centers such as Kaiser Permanente in California, diabetes reversal programs typically cost $500 per person. These programs typically include an initial assessment with a physician and follow up visits with a dietician, exercise specialist, and behavioral therapist.

Outside of medical centers, the cost of diabetes reversal programs is more variable and much lower. Online programs such as Virta Health typically cost between $400-$500 per month. These programs include visit with a physician, nutritionist, and personal health coach.

Overall, the cost of diabetes reversal programs in the United States is highly variable and largely dependent on the type of program and services offered. While there are many options available to people looking to reverse their diabetes, it is important for them to do their research to determine which program best fits their needs and budget.

PCG Suggestions:

It is financially responsible and viable to coordinate with your local Diabetes expert and nearby nutritionists to possibly consider a Diabetes Treatment Program that addresses the above costs and lifestyle changes needed to control their Diabetes. As a hospital and/or Payer you could create this program as a part of your healthier family and/or community outreach programs and attempt to gain local, state, and/or Federal Grant money to support.

Diabetes Amputation Costs

The cost of a diabetes amputation from a hospital is highly variable and can depend on several factors, including the type of procedure being performed (e.g., transmetatarsal amputation, partial foot amputation, below-knee amputation, or above knee amputation), the complexity of the surgery, where it is being performed, and the type of insurance coverage you have (if any). Generally, in the United States, amputations can cost anywhere between $15,000 and $50,000. According to the American Diabetes Association (ADA), lower-limb amputations due to diabetes contribute approximately $25 billion annually in direct medical costs alone. To find the actual fees and pricing hospitals can integrate VEWS or VE into their billing systems which allows for Medicare, AMA, and CMS edits to be applied to your GPCI allowing you to run mock adjudications and prepare your hospital and patient fees faster. For more information, contact PCG today by clicking this LINK.

Diabetes Related Billing Codes

Hospital Diabetes Billing Codes

Hospital billing codes for diabetes admission and readmission vary depending on the facility, but there are some that are used more commonly. One of the most common codes is ICD-10-CM E11.22, which is used to denote Type 2 Diabetes with complications requiring hospital admission. Another code used frequently is ICD-10-CM E11.9, which is used to denote Type 2 Diabetes Mellitus without mention of complications or manifestation. Other common codes include ICD-10-CM E08 and ICD-10-CM E09, which are both used to denote diabetes mellitus due to underlying conditions. Finally, HCPCS Level II code G9011 is commonly used to signify hospital admission for diabetes self-management training.

It is important to note that some facilities may have their own codes and protocols for billing diabetes admissions and readmissions, so it is best to look for AI Coding software that is continually updated and integrated with your EMR/EHR to ensure that your hospital is billing the correct codes to avoid denials and the $25-$40 cost per appeal.

Medical Clinic Diabetes Billing Codes

Clinic billing codes for diabetes vary depending on the clinic, but there are some that are used more commonly than others. One of the most common codes is ICD-10-CM E11.21, which is used to denote Type 1 Diabetes with ketoacidosis requiring hospital admission. Another code often used is ICD-10-CM E11.22, which is used to denote Type 2 Diabetes with complications requiring hospital admission. Other common codes include ICD-10-CM E08 and ICD-10-CM E09, which are both used to denote diabetes mellitus due to underlying conditions. Additionally, HCPCS Level II code G0108 is often used to signify diabetes outpatient self-management training services. To avoid denials PCG Software offers IVECoder which would allow your clinics to verify diagnosis codes, billing, and codes, and even run mock adjudications to ensure the highest probability for approval, as well as an easy reference guide to run your appeals through.

Summary:

Diabetes continues to plague not just our physical lives but our healthcare costs by straining both personnel requirements and the cost of administering care. If your hospital, health plan, IPA, MSO, or clinic is struggling with managing the cost of diabetes billing Virtual Examiner, VEWS, and IVECoder can quickly identify your losses and educate and support you to submit and review diabetes-related services faster and more efficiently. Let us know how PCG can help by contacting us today.